[Question #13760] Follow up to #13737 - herpetic urethritis?
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25 days ago
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Hi Terri - This is a follow up to my question from last week, #13737. I have some new information that I'd like to share and get your thoughts on.
I got a copy of the lab report and found that the test initially run was a PCR test on my urine by Quest. It shows positive for HSV-1 and HSV-2.
I had blood drawn on 1/22 and the results came back today as negative for both HSV-1 and HSV-2 (IgG test). They suggested that I come back in another month or so to get repeat blood tests to confirm whether this is a new infection or not. That sounds consistent with your advice.
My question though relates to how accurate the initial urine test could be. My understanding is that the PCR test is highly sensitive and a positive result is highly accurate. On the other hand though, what are the odds that I recently contracted both HSV-1 and HSV-2 and only in my urethra?
Any additional thoughts you have here are appreciated. Thank you!
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25 days ago
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I should have added that my symptoms started improving about two days after I started the doxy. I finished the one week of doxy on 1/25 and as of today (1/27), I pretty much feel back to normal.
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Terri Warren, RN, Nurse Practitioner
24 days ago
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This is all quite confusing. I have only seen two instances in 43 years of practice where both HSV 1 and HSV 2 were isolated from a PCR sample. and these were probably 35 years ago. While HSV causes 2-3% of urethritis, and could be the source of your symptoms, I'm still not sure about that. Yes, you should repeat the IgG test in about 6 weeks. How long after your last sexual contact (intercourse or oral sex) did you do this IgG test?
Terri
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24 days ago
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I'm not sure whether to feel good or bad that you're also confused about this - haha.
This IgG test was taken just shy of 2 weeks (12-13 days) since my last sexual contact. That did include both unprotected oral and vaginal sex. She is a trusted partner and says she's negative for everything. I did have other contacts in the weeks and months prior to this partner that have included unprotected oral but protected vaginal in all but one instance.
Do you have any knowledge about how likely a false positive is when a PCR for HSV is done using urine? Or could there be something else making the test positive? As your response indicates, it seems as though it would be highly unusual to have a new infection of both at the same time let alone without a single visible lesion.
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Terri Warren, RN, Nurse Practitioner
24 days ago
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A false positive PCR is rare, but I'm not believing that you have both HSV 1 and HSV 2 from the same sample when you have a negative IgG. It would be possible that you had undiagnosed HSV 1 genitally from something previously, but to then test negative for both AND acquire HSV 2 from someone who says they test negative for everything would be really unusual. I think you should ask her if she test negative specifically for HSV 1 and 2. And if she hasn't testing, would she? When was the last time you received oral sex from someone different than her?
BTW, once you have HSV 2, you don't subsequently acquire HSV 1 but the reverse is not true. And the IgG test does miss 10-15% of HSV 1 compared to the gold standard western blot. I would recommend the western blot but the recommendation there is to wait 12 weeks to do that test after last sexual exposure.
The IgG test was done too soon after that contact to be accurate - you need more time. I would suggest that you wait another couple weeks and retest but please use labCorp as there are quite a few false positives on the Quest test that I have been finding over the years. You won't get in index value, just reactive or non-reactive.
Let me know how it goes, OK?
Terri
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